ASGE Annual GI Advanced Practice Provider Course (Virtual) - Onboarding (Day One) | March 2025-Third-Space Endoscopy-POEM and GPOEM

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The document outlines key information about POEM (Peroral Endoscopic Myotomy) and G-POEM (Gastric Peroral Endoscopic Myotomy), procedures for treating achalasia and gastroparesis, respectively. <br /><br />**POEM** is a minimally invasive procedure developed for achalasia, an esophageal motility disorder that results in difficulty swallowing due to the lower esophageal sphincter (LES) failing to relax. Achalasia can be diagnosed via high-resolution manometry, endoscopy, and esophagram, with three subtypes identified by the Chicago Classification. Management options include pharmacologic therapies, endoscopic treatments like botulinum toxin injection and pneumatic dilation, and surgical interventions like Heller Myotomy (LHM) and POEM. Candidate selection for POEM includes those with Type III achalasia or previous surgical history, while poor candidates might have coagulopathy or are unable to tolerate anesthesia.<br /><br />**Post-POEM care** involves observations, dietary modifications, and medications like PPIs, alongside monitoring for risks like esophageal perforation and reflux esophagitis. Comparative studies show POEM to be as effective as LHM but with a higher risk of GERD, while LHM has a reduced risk of erosive esophagitis.<br /><br />**G-POEM** treats gastroparesis, a disorder of delayed gastric emptying not due to obstruction. Diagnosis uses gastric emptying scans and endoscopy, with management incorporating dietary changes and drugs. G-POEM candidates typically have failed medication management and no mechanical obstruction. Post-procedure care includes dietary stages and preventative antibiotics.<br /><br />Comparative effectiveness between G-POEM and surgical pyloroplasty suggests similar efficacy but with a shorter hospital stay for G-POEM. Both POEM and G-POEM are noted to be safe, effective, and are subjects of ongoing research. Advanced practice providers play a crucial role in early symptom recognition, diagnostics, and patient pre- and post-procedural care.

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Katelyn Cookson, PA-C

Keywords

POEM

G-POEM

achalasia

gastroparesis

endoscopic myotomy

esophageal motility disorder

gastric emptying

Heller Myotomy

GERD

pyloroplasty